Some revisions may actually seem very familiar.
Even though you still have another year before ICD-10 goes in to effect, that doesn’t mean CMS has stopped preparing for the new diagnosis coding system. In fact, the agency recently released a transmittal that should help you clarify some of the rules surrounding how you’ll report these codes when insurers start requiring them on Oct. 1, 2015.
Changes Match ICD-9 Guidelines
CMS issued Transmittal 3020 on Aug. 8, and it announces revisions to the official ICD-10 Coding Guidelines which put them more in line with the current ICD-9 rules. For example, CMS revised the ICD-10 regs to now say, “Do not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reasons for the visit.”
Question: Our practice has been receiving queries for H1N1 vaccinations. What are our coding options and restrictions?
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A Brooklyn, NY healthcare clinic was raking in cash over the past several years, despite the fact that investigators say its medical director wasn’t even on site to perform the services being billed to Medicare and Medicaid.
Self-disclosure clause built in to nip fraud in the bud.
As promised, the Centers for Medicare & Medicaid Services (CMS) has finally revealed the dates of its latest ICD-10 testing opportunities. MLN Matters article MM8858, issued on Aug. 22, outlines the following date ranges when you can test out your ICD-10 claims:
- Nov. 17 to 21, 2014
- March 2 to 6, 2015
- June 1 to 5, 2015
During these periods, trading partners will have access to MACs and CEDI for testing “with real-time help desk support,” the article says.
The November 2014 CPT® Assistant is brimming with updates made in CPT® 2015 for reporting stomal endoscopy codes. Find out how the introduction of several new codes for colonoscopy through a stoma affects the reporting of various services. Evaluate the new guidelines, which instruct you on how to report colonoscopy codes during specific scenarios.
Other areas featured in the November 2014 CPT® Assistant address the changes and additions made in 2015 to the cardiovascular system subsection, including pacemaker and implantable defibrillator codes. Sharpen your skills for negative pressure therapy services, coding neoplasms in ICD-10-CM, and much more. Put SuperCoder.com’s Code Connect code and keyword search to good use to deepen your understanding of these topics:
- Coding Clarification: Special Ophthalmological Services: 92133, 92134, 92135, 92250
- ICD-10-CM: Neoplasm Coding and the Neoplasm Table
- Negative Pressure Therapy Services: 97605-97608
- Pacemaker or Implantable Defibrillator Systems: 10140, 10180, 11042, 11043, 11045, 11046, 11047, 33202-33249, 33262-33264, 33270-33273, 76000, 93260, 93261, 93279-93299, 0319T-0328T
- Stomal Endoscopy: 44360-44376, 44380-44408.
In 2015, look for debut of the L57.- codes.
In the Dermatology Coding Alert volume 10 number 10, we looked at how ICD-10 would change diagnosis coding for sunburn and other solar radiation-related skin conditions. This time, we’ll examine how your coding will change effective Oct. 1, 2015, for skin disorders caused by other sources of radiation.
ICD-10 contains a category of diagnoses relating to “Skin changes due to chronic exposure to nonionizing radiation,” which will map to ICD-9 codes that are now scattered among different sections. The new ICD-10 category, L57.-, consists of:
Question: The Feb. 2012 issue of the Ob-gyn Coding Alert has an example of CPT® 58100-endometrial sampling (biopsy) as: “…plastic catheter into the uterus and suctions out a small amount of the endometrial lining.” Dilation is bundled with 58100. If a provider does some cervical dilation along with an endometrial sampling, at what point do we change from coding a 58100, 58120-52 or 58120? I spoke with a provider who uses the plastic catheter suction device and states he does a 360 degree endometrial curettage, after dilating the cervix slightly and sounding the uterus. Another provider uses the same tool and states he does a 360 degree endometrial biopsy, after sounding the uterus and dilating the cervix as needed. Is there a clear CPT® guideline on what is considered a sampling/biopsy and what is considered a curettage? Both of these providers do this procedure with out anesthesia for menorrhagia.
Plus: MACs to increase minimum dollar amounts for appeals in 2015
You’ve heard there won’t be an ICD-10 book that you can keep on your desk because the abundance of codes would make a book too thick—but is that tale true? Actually, no—it’s one of many ICD-10 myths that CMS hopes to dispel with its latest publication, called ICD-10-CM/PCS Myths and Facts.
Know the difference between 10040 and 17110.
Milia treatments can be notoriously challenging to report, in part because it can be difficult to discern between acne surgery codes and destruction codes. Is one of these four myths causing reimbursement hassles in your dermatology practice?
Myth: 10040 and 17110 Are Interchangeable
Reality: The main difference between 10040 (Acne surgery — e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) and 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) is that the 17110 code is a destruction while the 10040 code is a removal.
Determine whether you’ll be ready for the new coding system with this sample note.
Although you’re probably a professional at coding your pediatric documentation at this point using ICD-9 codes, chances are high that you haven’t yet coded a note using only ICD-10 codes. Test yourself using this documentation example to determine whether you can select the right diagnosis codes, which will be required as of Oct. 1. Determine which ICD-10 codes you would report, then read on for the answers.
Scenario: An eight-year-old established patient presents for a well child visit. While there, the patient’s mother says that the child has recently needed to use his asthma inhaler twice a week, which has limited his activities of daily living to a slight extent, including his need to sit on the bleachers during his physical education class. Although the patient has had mild persistent asthma for a while, this is the first exacerbation that the parent has reported. Which ICD-10 codes should you report for this visit?